Provider Demographics
NPI:1710584677
Name:PACHECO, ANTHONY CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHARLES
Last Name:PACHECO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N POST OAK ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-2033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 W DALLAS AVE
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432-1721
Practice Address - Country:US
Practice Address - Phone:903-629-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty